导航经颅磁刺激联合问题管理家(PM+)治疗对青少年抑郁症伴非自杀性自伤行为的疗效OA

Objective:To explore the therapeutic efficacy of navigated transcranial magnetic stimulation(nTMS)combined with problem management Plus(PM+)in the treatment of adolescents with depression and non-suicidal self-injury(NSSI).Methods:A total of 120 adolescent patients with depression and NSSI admitted to Nanyang Fourth People's Hospital from January 2024 to May 2025 were selected.The patients were randomly divided into a control group and an observation group.Both groups were given oral Escitalopram Oxalate Tablets.The control group(60 cases)was treated with nTMS,while the observation group(60 cases)received combined treatment with PM+on the basis of the control group.The 17-item Hamilton Depression Rating Scale(HAMD-17)was used to assess the severity of depression,the Ottawa Self-Injury Scale(OSI)to assess self-injury status,the Wisconsin Card Sorting Test(WCST)to assess cognitive function,and the Quality of Life Scale for Children and Adolescents(QLSCA)to as-sess quality of life before and after treatment.Results:There was no significant difference in the dropout rate between the two groups(Observation group:5.00％vs.Control group:6.67％).The effective rate in the observation group(85.96％)was significantly higher than that in the control group(69.64％)(x2=5.610,P＜0.05).After intervention,the HAMD-17 scores in both groups decreased significantly compared with those before intervention(t=48.664,35.049;P＜0.001),and the decrease in the observation group was more significant(t=2.993,P＜0.01).Regarding OSI indicators,the incidence of self-injurious behavior decreased in both groups,with a significant difference be-tween the groups(x2=4.400,P＜0.05).The addiction scores decreased and self-control scores increased in both groups(t=40.740,-34.061,33.175,-29.841;P＜0.001),and the changes in addiction scores and self-control scores were more obvious in the observation group(t=9.022,-7.613;P＜0.05).In the WCST assessment,the total number of responses,number of persistent errors,and number of non-persistent errors decreased,while the number of cor-rect responses and number of categories completed increased in both groups(P＜0.001).The observation group showed significantly greater improvements in the total number of responses,number of persistent errors,number of correct responses,and number of categories completed(t=25.194,6.516,-11.309,-3.178;P＜0.01).In the QLSCA assessment,scores in psychosocial function,physiological function,living environment,and life satisfaction increased significantly in both groups compared with baseline(P＜0.001),and the increases were more significant in the obser-vation group(t=-4.664,-3.316,-2.367,-4.553;P＜0.05).Conclusion:Navigated transcranial magnetic stimulation combined with problem management Plus(PM+)can effectively reduce self-injurious behaviors in adolescents with depression,significantly improve clinical efficacy,and notably enhance patients' cognitive function and quality of life.